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Peer-reviewedCC BYCase reports in dermatological medicine

Mucosal-First Pemphigus Vulgaris With Delayed Generalized Bullous Eruption: A Case Report.

  • Ammir Abuzahra1,2
  • Bahaa Mohammed Abdalwahab Khawarh2,3
  • Khadija Ideas1,2
  • Jihad Ibrahim Abdalwahab Alkhawarh2,3
  • Diana Daghamin1,2
  • Jafar M A Ihryzat2
  • Ibrahim Ideas2
  1. 1College of Medicine Hebron University Hebron State of Palestine hebron.edu.
  2. 2Abu Al Hassan Al Kassem Hospital Yatta State of Palestine.
  3. 3Faculty of Medicine Kafr El Sheikh University Kafr El Sheikh Egypt kfs.edu.eg.
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Abstract

Background

Pemphigus vulgaris (PV) may initially present with persistent oral erosions and can be mistaken for infectious or inflammatory mucosal disease.Case description

A previously healthy 43-year-old woman developed recurrent painful oral erosions that persisted despite multiple antifungal and antibacterial treatments. An initial biopsy from a necrotic oral ulcer was nondiagnostic. Following substantial oral improvement, she developed a generalized painful vesiculobullous eruption involving approximately 12% of the body surface area. Nikolsky sign was positive. Repeat skin biopsy demonstrated suprabasal acantholysis and blister formation, strongly supporting PV. She was treated with oral prednisolone 60 mg/day followed by a six-week taper, together with topical clobetasol. Cutaneous lesions had clinically cleared by approximately 25 August 2026. At follow-up on 7 September 2026, approximately 13 days after cutaneous clearance, no active oral or cutaneous lesions or documented recurrence were present.Conclusion

This case highlights the diagnostic importance of appropriate biopsy-site selection in persistent oral erosions and the value of repeat biopsy from an active lesion. Because direct immunofluorescence and antidesmoglein serology were not performed, the diagnosis is best regarded as probable, histopathologically supported PV rather than immunopathologically confirmed PV.

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Cite

BibTeXRIS
BibTeX
@article{abuzahra2026mucosalfirst,
  title = {{Mucosal-First Pemphigus Vulgaris With Delayed Generalized Bullous Eruption: A Case Report.}},
  author = {Ammir Abuzahra and Bahaa Mohammed Abdalwahab Khawarh and Khadija Ideas and Jihad Ibrahim Abdalwahab Alkhawarh and Diana Daghamin and Jafar M A Ihryzat and Ibrahim Ideas},
  journal = {Case reports in dermatological medicine},
  year = {2026},
  month = oct,
  doi = {10.1155/crdm/3595737},
  url = {https://europepmc.org/article/MED/42924068},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Mucosal-First Pemphigus Vulgaris With Delayed Generalized Bullous Eruption: A Case Report.
AU  - Ammir Abuzahra
AU  - Bahaa Mohammed Abdalwahab Khawarh
AU  - Khadija Ideas
AU  - Jihad Ibrahim Abdalwahab Alkhawarh
AU  - Diana Daghamin
AU  - Jafar M A Ihryzat
AU  - Ibrahim Ideas
PY  - 2026
DA  - 2026/10/22
JO  - Case reports in dermatological medicine
DO  - 10.1155/crdm/3595737
UR  - https://europepmc.org/article/MED/42924068
AB  - Background  Pemphigus vulgaris (PV) may initially present with persistent oral erosions and can be mistaken for infectious or inflammatory mucosal disease.Case description  A previously healthy 43-year-old woman developed recurrent painful oral erosions that persisted despite multiple antifungal and antibacterial treatments. An initial biopsy from a necrotic oral ulcer was nondiagnostic. Following substantial oral improvement, she developed a generalized painful vesiculobullous eruption involving approximately 12% of the body surface area. Nikolsky sign was positive. Repeat skin biopsy demonstrated suprabasal acantholysis and blister formation, strongly supporting PV. She was treated with oral prednisolone 60 mg/day followed by a six-week taper, together with topical clobetasol. Cutaneous lesions had clinically cleared by approximately 25 August 2026. At follow-up on 7 September 2026, approximately 13 days after cutaneous clearance, no active oral or cutaneous lesions or documented recurrence were present.Conclusion  This case highlights the diagnostic importance of appropriate biopsy-site selection in persistent oral erosions and the value of repeat biopsy from an active lesion. Because direct immunofluorescence and antidesmoglein serology were not performed, the diagnosis is best regarded as probable, histopathologically supported PV rather than immunopathologically confirmed PV.
SN  - 2090-6463
SN  - 2090-6471
ER  -